Forward view analysis: A flag to rally round

The NHS Five Year Forward View is a smart document: visionary, engaging, commendably short. It elegantly captures much of the current consensus on priorities for health reform. It symbolises this consensus by presenting itself as the joint work of six national system leading bodies.

It launches a cleverly pitched bid for resources that, judging by the recent autumn statement, has already had some effect.

The forward view speaks compellingly about the engagement of patients, carers, volunteers and the voluntary sector. It powerfully makes the case that such approaches are not “nice to haves” but integral parts of the health and care endeavour.

Put patients first

We in the voluntary sector are used to airy generalities about “putting patients first”. But the forward view contains specific commitments that, if implemented, will make a difference.

It signals an intent to invest in evidence based approaches for people with long term conditions, to identify and support hidden carers, to bolster volunteering and to simplify the contractual minefield for voluntary sector organisations, especially those too small to compete for tenders.

‘The forward view doesn’t overcome the NHS/public health/social care divides’

I declare an interest since National Voices and a number of other national voluntary organisations have had the opportunity to shape some of this content. The soaring phraseology about “the NHS as a social movement” and about harnessing “the renewable energy represented by patients and communities” is, however, Simon Stevens’ own.

What are the prospects for harnessing this “renewable energy”? At National Voices we are optimistic, but wary.

The scale of change implied by the forward view is considerable. It requires political backing, money, time, headspace and change management expertise. It demands a willingness to engage, share, collaborate and let go.

These are tender plants, scarce at the best of times. And the current state of the NHS - a frantic effort to keep the existing show on the road - does not provide fertile soil for them to grow.

In our position statement Person Centred Care 2020, National Voices calls on political and health leaders to “make people the priority, not the system”.

Despite the patient friendly language, time and again we see professional, financial and organisational priorities trumping the priorities of patients and their families.

Making it real

To reverse this imbalance is the biggest challenge for reform, but key to making the forward view real.

We see the imbalance in action when access to services is rationed; when people are “blamed” for turning up at accident and emergency; when they experience the over-medicalised death they didn’t want; when they find themselves endlessly “passed from pillar to post”.

We see it in positive developments too, so that, for example, the purpose of integrated care initiatives becomes framed as reducing cost and hospital admissions, rather than improving health and quality of life.

We see it in NHS England right now, as it presides over yet another reorganisation of specialised commissioning in the face of considerable concern from patient organisations and leaders.

‘Even the forward view itself is not immune from this “system” thinking’

Even the forward view itself is not immune from this “system” thinking. While the whole of chapter two is devoted to “a new relationship with patients and communities”, chapter three on “new models of care” barely refers to this, and nor does chapter four on implementation.

Mr Stevens exhorts the NHS to “think like a patient, act like a taxpayer” but the forward view unconsciously betrays an older NHS mindset: “think occasionally about patients, act like a technocrat”.

And of course there are other problems with the forward view. As an NHS document it doesn’t overcome the NHS/public health/social care divides.

It doesn’t integrate the implications of the Care Act or the Barker commission. It is the imperfect child of an imperfect system.

Breath life into new models

For all that, the forward view feels like the only game in town right now - a flag that everyone can rally round. We are keen to play our part.

‘We need less “system”, more “people”’

Let’s start by breathing human life into the new care models. They should be vehicles for “mainstreaming” person centred coordinated care. They must herald a new deal for people with long term conditions realised through care and support planning.

They must integrate the rich contributions of the voluntary and community sector to health, holistic care, independence and wellbeing. We need less “system”, more “people”.

Jeremy Taylor is chief executive of National Voices